Session Information
Date: Sunday, October 21, 2018
Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster I: Comorbidities
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Depression in patients with rheumatoid arthritis (RA) may be pre-existent, amplified, or newly-developed after onset of RA. Together with other comorbidities, socioeconomic factors, education level or affective factors can influence perception of pain, functional disability, and health status. The prevalence of depression in RA patients has been estimated to be 19% over 5 years and affect remission rates according to a classical composite index (Leblanc-Trudeau, C et al. Rheumatology 2015;54:2205-14). We compared patient self-reported scores included in the Multidimensional Health-Assessment Questionnaire (MDHAQ) and levels of remission according to RAPID3 in patients who reported depression versus no report of depression.
Methods:
All patients, regardless diagnoses, complete a MDHAQ at each visit in the waiting area before seeing the rheumatologist at all visits. The 2-page MDHAQ includes physical function (FN) in 10 activities of daily living, three 0-10 visual analogue scales (VAS) for pain (PN), patient global estimate (PATGL), fatigue (FT), RADAI self-report joint count, a review of 60 symptom checklist, three 0 to 3.3 scores for depression, anxiety, and sleep quality, and demographic data. RAPID3 (0-30) is the sum of 0-10 scores from FN, PN, and PATGL; remission corresponds to a RAPID3 value ≤3. Patients with RA (physician ICD9 and ICD10 diagnosis) were classified according to self-report of checking depression as part of a symptoms checklist. A retrospective chart review was conducted to evaluate the percentage of patients with treatment or specialist evaluation for depression. Demographic and clinical characteristics were compared according to self-reported depression status using Student t-test and chi-square test.
Results:
Overall 464 RA patients were included in the analysis, of which 118 (25%) self-reported depression in the last month. Only 37 (31%) of all patients reporting depression had evidence in the medical record of treatment and/or specialist evaluation for depression. Mean age (SD) was 55.5 (14.9) and 86% were female, with no difference between depression groups. Patients reporting depression had lower education level (12.5 vs 14.3, p<0.001) and poorer scores for physical function, pain, and patient global leading to higher RAPID3 and lower percentage of patient in remission (12.4 vs 4%, p<0.001) (Table). Depressed patients also reported higher scores for fatigue, number of painful joints, number or symptoms, and more difficulty with sleep, and anxiety (Table).
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Table: MDHAQ/RAPID3 patient self-report scores in patients with rheumatoid arthritis according of their depression status. Data are presented as mean (SD) and percentages. Comparisons by Student t-test and chi-square test. |
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No self-reported depression N= 346 (75%) |
Self-reported depression N= 118 (25%) |
p |
|
Demographic variables |
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|
Age, years |
55.4 (14.9) |
55.8 (15.1) |
0.80 |
|
Female, % |
84% |
91% |
0.08 |
|
Education level, years |
14.3 (3.1) |
12.5 (3.4) |
<0.001 |
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MDHAQ/RAPID3: Patient self-report scores |
|||
|
Physical function (0-10) |
2.4 (2.0) |
3.4 (1.9) |
<0.001 |
|
Pain (0-10) |
5.3 (3.0) |
6.8 (2.6) |
<0.001 |
|
Patient global estimate (0-10) |
4.9 (3.0) |
6.6 (2.7) |
<0.001 |
|
RAPID3 (0-30) |
12.6 (7.2) |
16.6 (6.4) |
<0.001 |
|
% patients in RAPID3 remission |
12.4% |
4% |
<0.001 |
|
Fatigue (0-10) |
4.2 (3.2) |
6.3 (3.0) |
<0.001 |
|
Self-reported joint pain-RADAI (0-48) |
12 (10) |
18 (12) |
<0.001 |
|
Review of Symptoms (0-60) |
8 (7) |
18 (9) |
<0.001 |
|
Sleep problems (0-3.3) |
1.1 (0.9) |
1.9 (0.9) |
<0.001 |
|
Dealing with depression/feeling blue (0-3.3) |
1.1 (0.9) |
1.9 (0.9) |
<0.001 |
|
Dealing with anxiety/being nervous (0-3.3) |
0.1 (0.4) |
0.7 (0.4) |
<0.001 |
Conclusion:
The prevalence of self-reported depression in our RA patients was 25%, with only 31% treated for this condition. RA patients with self-reported depression exhibit higher scores for all MDHAQ patient-reported outcomes, including to a lower rate of RAPID3 remission. MDHAQ/RAPID3 may be useful to identify patients with depression in busy clinical settings.
To cite this abstract in AMA style:
Castrejón I, Riad M, Chua JR, Pincus T. Self-Reported Depression in Patients with Rheumatoid Arthritis Is Undertreated and Associated with Poorer Clinical Status and Lower Rates of Remission in Routine Care [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/self-reported-depression-in-patients-with-rheumatoid-arthritis-is-undertreated-and-associated-with-poorer-clinical-status-and-lower-rates-of-remission-in-routine-care/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/self-reported-depression-in-patients-with-rheumatoid-arthritis-is-undertreated-and-associated-with-poorer-clinical-status-and-lower-rates-of-remission-in-routine-care/